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Toward a Rational, Value-Based Drug Benefit for Medicare |
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From The Commonwealth Fund: While Medicare beneficiaries give high marks to the new prescription drug benefit, the actual performance of Medicare Part D has so far been mixed. With support from The Commonwealth Fund, two health policy experts outline steps for putting the drug benefit onto a more value-driven path. At a time when pharmaceutical companies are reporting record-high profits, some lawmakers are pushing to lift the current ban on government intervention in price negotiations with drug manufacturers. A long-term objective should be integrating drug benefits with comprehensive health coverage, the authors say. "A CMS plan would require a comprehensive but closed formulary, built on transparent, evidence-based assessments of comparative effectiveness and value for money," the researchers say. This may result in limiting the number of generic or brand versions of the drug, or the number of choices within a therapeutic class, as well as limiting the indications for which a drug is reimbursed. A patient's contribution should not vary with the cost of a drug, the authors say, and beneficiaries should not have to wonder how much they will be required to pay at the pharmacy. An alternative approach: introducing a form of reference pricing, or setting the price for all drugs in a group at the same level, except when evidence supports a clinically important difference in patient outcome. "An integrated benefit with treatment options based on assessments of effectiveness and cost-effectiveness would ensure that early and judicious use of preventive drug therapies is encouraged by an understanding of downstream outcomes and cost offsets," the authors conclude.
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